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Waste Tire SL .'ey & Inspection Rep y SURVEY REQUIRED : <br /> •�_��' State of California <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- InspectionReport <br /> �s/f �/ <br /> Site Suffix: I � u� i ? 7 �� Number: I Cj <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> `, <br /> A mcwt L �C) ��J-t ve'l, lze jRe- - 4c,V- -tk i(I <br /> AR 't-mein,� 4,)-h exi-frnIJr tc MI-AC & o <br /> le, Cn, <br /> 1k.2 St <br /> FE x A M P L E 1 ;A� 42408 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />